The evolution of pediatric transfusion practice during combat operations 2001-2013

Jeremy W. Cannon, Lucas P. Neff, Heather F. Pidcoke, James K. Aden, Philip C. Spinella, Michael A. Johnson, Andrew P. Cap, Matthew A. Borgman

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

BACKGROUND: Hemostatic resuscitation principles have significantly changed adult trauma resuscitation over the past decade. Practice patterns in pediatric resuscitation likely have changed as well; however, this evolution has not been quantified. We evaluated pediatric resuscitation practices over time within a combat trauma system. METHODS: The Department of Defense Trauma Registry was queried from 2001 to 2013 for pediatric patients (<18 years). Patients with burns, drowning, and missing injury severity score were excluded. Volumes of crystalloid, packed red blood cells (PRBC), whole blood, plasma, and platelets (PLT) given in the first 24 hours were calculated per kilogram body weight. Tranexamic acid use was also determined. Patients were divided into Early (2001-2005) and Late (2006-2013) cohorts, and subgroups of transfused (TX+) and massively transfused (MT+) patients were created. Intensive care unit and hospital length of stay and 24-hour and in-hospital mortality rates were compared. RESULTS: A total of 4,358 patients met inclusion criteria. Comparing Early versus Late, injuries from explosions, isolated or predominant head injuries, and injury severity score all increased. The proportion of TX+ patients also increased significantly (13.6% vs 37.4%, p < 0.001) as did the number of MT+ patients (2.1% vs 15.5%, p < 0.001). Transfusion of high plasma:RBC and PLT:RBC ratios increased in both the TX+ and MT+ subgroups, although overall, PLT and whole blood use was low. After adjusting for differences between groups, the odds of death was no different Early versus Late but decreased significantly in the MT+ patients with time as a continuous variable. CONCLUSION: Transfusion practice in pediatric combat casualty care shifted toward a more hemostatic approach over time. All-cause mortality was low and remained stable overall and even decreased in MT+ patients despite more injuries due to explosions, more head injuries, and greater injury severity. However, further study is required to determine the optimal resuscitation practices in critically injured children. LEVEL OF EVIDENCE: Epidemiologic study, level IV.

Original languageEnglish (US)
Pages (from-to)S69-S76
JournalThe journal of trauma and acute care surgery
Volume84
Issue number6S Suppl 1
DOIs
StatePublished - Jun 1 2018

Fingerprint

Pediatrics
Resuscitation
Wounds and Injuries
Injury Severity Score
Blood Platelets
Explosions
Hemostatics
Craniocerebral Trauma
Length of Stay
Tranexamic Acid
Mortality
Hospital Mortality
Burns
Intensive Care Units
Registries
Epidemiologic Studies
Erythrocytes
Body Weight

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Cannon, J. W., Neff, L. P., Pidcoke, H. F., Aden, J. K., Spinella, P. C., Johnson, M. A., ... Borgman, M. A. (2018). The evolution of pediatric transfusion practice during combat operations 2001-2013. The journal of trauma and acute care surgery, 84(6S Suppl 1), S69-S76. https://doi.org/10.1097/TA.0000000000001869

The evolution of pediatric transfusion practice during combat operations 2001-2013. / Cannon, Jeremy W.; Neff, Lucas P.; Pidcoke, Heather F.; Aden, James K.; Spinella, Philip C.; Johnson, Michael A.; Cap, Andrew P.; Borgman, Matthew A.

In: The journal of trauma and acute care surgery, Vol. 84, No. 6S Suppl 1, 01.06.2018, p. S69-S76.

Research output: Contribution to journalArticle

Cannon, JW, Neff, LP, Pidcoke, HF, Aden, JK, Spinella, PC, Johnson, MA, Cap, AP & Borgman, MA 2018, 'The evolution of pediatric transfusion practice during combat operations 2001-2013', The journal of trauma and acute care surgery, vol. 84, no. 6S Suppl 1, pp. S69-S76. https://doi.org/10.1097/TA.0000000000001869
Cannon, Jeremy W. ; Neff, Lucas P. ; Pidcoke, Heather F. ; Aden, James K. ; Spinella, Philip C. ; Johnson, Michael A. ; Cap, Andrew P. ; Borgman, Matthew A. / The evolution of pediatric transfusion practice during combat operations 2001-2013. In: The journal of trauma and acute care surgery. 2018 ; Vol. 84, No. 6S Suppl 1. pp. S69-S76.
@article{10d4a44e135343deb421c8284a95e535,
title = "The evolution of pediatric transfusion practice during combat operations 2001-2013",
abstract = "BACKGROUND: Hemostatic resuscitation principles have significantly changed adult trauma resuscitation over the past decade. Practice patterns in pediatric resuscitation likely have changed as well; however, this evolution has not been quantified. We evaluated pediatric resuscitation practices over time within a combat trauma system. METHODS: The Department of Defense Trauma Registry was queried from 2001 to 2013 for pediatric patients (<18 years). Patients with burns, drowning, and missing injury severity score were excluded. Volumes of crystalloid, packed red blood cells (PRBC), whole blood, plasma, and platelets (PLT) given in the first 24 hours were calculated per kilogram body weight. Tranexamic acid use was also determined. Patients were divided into Early (2001-2005) and Late (2006-2013) cohorts, and subgroups of transfused (TX+) and massively transfused (MT+) patients were created. Intensive care unit and hospital length of stay and 24-hour and in-hospital mortality rates were compared. RESULTS: A total of 4,358 patients met inclusion criteria. Comparing Early versus Late, injuries from explosions, isolated or predominant head injuries, and injury severity score all increased. The proportion of TX+ patients also increased significantly (13.6{\%} vs 37.4{\%}, p < 0.001) as did the number of MT+ patients (2.1{\%} vs 15.5{\%}, p < 0.001). Transfusion of high plasma:RBC and PLT:RBC ratios increased in both the TX+ and MT+ subgroups, although overall, PLT and whole blood use was low. After adjusting for differences between groups, the odds of death was no different Early versus Late but decreased significantly in the MT+ patients with time as a continuous variable. CONCLUSION: Transfusion practice in pediatric combat casualty care shifted toward a more hemostatic approach over time. All-cause mortality was low and remained stable overall and even decreased in MT+ patients despite more injuries due to explosions, more head injuries, and greater injury severity. However, further study is required to determine the optimal resuscitation practices in critically injured children. LEVEL OF EVIDENCE: Epidemiologic study, level IV.",
author = "Cannon, {Jeremy W.} and Neff, {Lucas P.} and Pidcoke, {Heather F.} and Aden, {James K.} and Spinella, {Philip C.} and Johnson, {Michael A.} and Cap, {Andrew P.} and Borgman, {Matthew A.}",
year = "2018",
month = "6",
day = "1",
doi = "10.1097/TA.0000000000001869",
language = "English (US)",
volume = "84",
pages = "S69--S76",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "6S Suppl 1",

}

TY - JOUR

T1 - The evolution of pediatric transfusion practice during combat operations 2001-2013

AU - Cannon, Jeremy W.

AU - Neff, Lucas P.

AU - Pidcoke, Heather F.

AU - Aden, James K.

AU - Spinella, Philip C.

AU - Johnson, Michael A.

AU - Cap, Andrew P.

AU - Borgman, Matthew A.

PY - 2018/6/1

Y1 - 2018/6/1

N2 - BACKGROUND: Hemostatic resuscitation principles have significantly changed adult trauma resuscitation over the past decade. Practice patterns in pediatric resuscitation likely have changed as well; however, this evolution has not been quantified. We evaluated pediatric resuscitation practices over time within a combat trauma system. METHODS: The Department of Defense Trauma Registry was queried from 2001 to 2013 for pediatric patients (<18 years). Patients with burns, drowning, and missing injury severity score were excluded. Volumes of crystalloid, packed red blood cells (PRBC), whole blood, plasma, and platelets (PLT) given in the first 24 hours were calculated per kilogram body weight. Tranexamic acid use was also determined. Patients were divided into Early (2001-2005) and Late (2006-2013) cohorts, and subgroups of transfused (TX+) and massively transfused (MT+) patients were created. Intensive care unit and hospital length of stay and 24-hour and in-hospital mortality rates were compared. RESULTS: A total of 4,358 patients met inclusion criteria. Comparing Early versus Late, injuries from explosions, isolated or predominant head injuries, and injury severity score all increased. The proportion of TX+ patients also increased significantly (13.6% vs 37.4%, p < 0.001) as did the number of MT+ patients (2.1% vs 15.5%, p < 0.001). Transfusion of high plasma:RBC and PLT:RBC ratios increased in both the TX+ and MT+ subgroups, although overall, PLT and whole blood use was low. After adjusting for differences between groups, the odds of death was no different Early versus Late but decreased significantly in the MT+ patients with time as a continuous variable. CONCLUSION: Transfusion practice in pediatric combat casualty care shifted toward a more hemostatic approach over time. All-cause mortality was low and remained stable overall and even decreased in MT+ patients despite more injuries due to explosions, more head injuries, and greater injury severity. However, further study is required to determine the optimal resuscitation practices in critically injured children. LEVEL OF EVIDENCE: Epidemiologic study, level IV.

AB - BACKGROUND: Hemostatic resuscitation principles have significantly changed adult trauma resuscitation over the past decade. Practice patterns in pediatric resuscitation likely have changed as well; however, this evolution has not been quantified. We evaluated pediatric resuscitation practices over time within a combat trauma system. METHODS: The Department of Defense Trauma Registry was queried from 2001 to 2013 for pediatric patients (<18 years). Patients with burns, drowning, and missing injury severity score were excluded. Volumes of crystalloid, packed red blood cells (PRBC), whole blood, plasma, and platelets (PLT) given in the first 24 hours were calculated per kilogram body weight. Tranexamic acid use was also determined. Patients were divided into Early (2001-2005) and Late (2006-2013) cohorts, and subgroups of transfused (TX+) and massively transfused (MT+) patients were created. Intensive care unit and hospital length of stay and 24-hour and in-hospital mortality rates were compared. RESULTS: A total of 4,358 patients met inclusion criteria. Comparing Early versus Late, injuries from explosions, isolated or predominant head injuries, and injury severity score all increased. The proportion of TX+ patients also increased significantly (13.6% vs 37.4%, p < 0.001) as did the number of MT+ patients (2.1% vs 15.5%, p < 0.001). Transfusion of high plasma:RBC and PLT:RBC ratios increased in both the TX+ and MT+ subgroups, although overall, PLT and whole blood use was low. After adjusting for differences between groups, the odds of death was no different Early versus Late but decreased significantly in the MT+ patients with time as a continuous variable. CONCLUSION: Transfusion practice in pediatric combat casualty care shifted toward a more hemostatic approach over time. All-cause mortality was low and remained stable overall and even decreased in MT+ patients despite more injuries due to explosions, more head injuries, and greater injury severity. However, further study is required to determine the optimal resuscitation practices in critically injured children. LEVEL OF EVIDENCE: Epidemiologic study, level IV.

UR - http://www.scopus.com/inward/record.url?scp=85064775218&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85064775218&partnerID=8YFLogxK

U2 - 10.1097/TA.0000000000001869

DO - 10.1097/TA.0000000000001869

M3 - Article

C2 - 29554046

AN - SCOPUS:85064775218

VL - 84

SP - S69-S76

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 6S Suppl 1

ER -